Esmolol as an Adjunct in Multimodal Anesthesia: A Systematic Review and Meta-Analysis of Its Opioid-Sparing and Analgesic Effects
Authors' conclusion
Esmolol infusion significantly reduces opioid consumption and postoperative pain, with a magnitude of effect that may have clinical significance.
Study context
- Population
- Patients undergoing surgery (minimally invasive to open intracavitary) under multimodal anesthesia
- Participants
- 1,028 patients · 19 RCTs
- Comparison
- Continuous intraoperative esmolol infusion vs placebo
- Outcome
- Total intraoperative and postoperative opioid consumption (IV MME) and pain intensity (visual analog scale (VAS) or Numeric Rating Scale (NRS), standardized 0 to 10)
- Follow-up
- First 24 hours after surgery
Methodological detailsplacebo-controlled trials only, random-effects model, meta-regression, subgroup analyses
- Placebo-controlled trials only
- Random-effects model
- Meta-regression
- Subgroup analyses
Pooled result
As reported in the abstract
Intraoperative and postoperative opioid consumption (IV MME); pain scores (0 to 10 scale)
Esmolol vs PlaceboMD, IV MME (95% CI)P value
Intraoperative opioid consumption; reduced in 32%; I² = 93.6%
−12.89(−24.74 to −1.05)
P < 0.001Postoperative opioid consumption; reduced 38.6%; I² = 89.9%
−3.03(−4.29 to −1.76)
P < 0.001- Pain score within 30 minutes, MD (95% CI; P); 27.3% reduction vs weighted placebo mean
- −1.47 (−2.02 to −0.93; P < .001)
- Pain score between 2 and 4 hours, MD (95% CI; P); 15.8% reduction vs weighted placebo mean
- −0.67 (−1.29 to −0.06; P = .032)
- Pain score at 24 hours, MD (95% CI; P); 23.5% reduction vs weighted placebo mean
- −0.48 (−0.92 to −0.03; P =.038)
Further pooled results
- Esmolol significantly reduced intraoperative heart rate in most cases and lowered MAP at multiple time points in several studies
Safety
- Studies noting higher ephedrine and atropine use
- 1
- No significant increase in hypotension or bradycardia reported
Original publication
Esmolol as an Adjunct in Multimodal Anesthesia: A Systematic Review and Meta-Analysis of Its Opioid-Sparing and Analgesic Effects. Anesth Analg. Published 24 October 2025. doi:10.
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